Personal responsibility key in tackling global health care crisis
Few paid much attention when Finland’s entire government resigned in March. Tucked away in the far north, Finnish affairs rarely intrude upon the world’s headlines. But what happened on March 8 was equivalent to the opening scene in a disaster movie — an earthquake in some distant wilderness that spooks the wildlife and foreshadows a global catastrophe. Finland’s government was brought down by a single issue: The failure to fix the country’s increasingly unaffordable health system. It is an issue facing almost every society today.
Falling birth rates in the developed world are reducing the supply of productive taxpayers. At the same time, health care improvements are swelling the ranks of the elderly. A century ago, the average global life expectancy was little more than 35 years. Today, it is more than 72 years. In 2016, there were just five countries designated by the World Health Organization (WHO) as “super-aged,” meaning one in five of the population is 65 or older. By 2030 there will be 34.
This good news for individuals comes with a downside, signaled by the acronym HALE — Health Adjusted Life Expectancy. If trends continue, a person born today will live about seven years longer than one born in 2000, which itself poses difficulties for systems designed to cater for shorter lifespans. Worse, thanks to the rise of lifestyle conditions such as diabetes and obesity, many of those extra years will be spent in increasingly poor and expensive-to-treat health.
Life expectancy in all the wealthy Gulf states is 77 years, the same as in Europe and with the same attendant health problems, which are accelerating in the Gulf just as rapidly as the economic development that followed the discovery of oil. WHO statistics show that, while obesity has tripled worldwide since 1975, some of the most dramatic increases have occurred in Kuwait, Qatar, the UAE, Saudi Arabia and Bahrain. Similarly, Gulf Cooperation Council states have the dubious honor of occupying many of the top slots in a table of nations with the highest incidence of lifestyle-induced Type 2 diabetes — 20 percent of adults in Kuwait, rising to 29 percent in the UAE and 55 percent in Bahrain.
Across the Middle East, 35 million adults are living with diabetes, an entirely avoidable condition that in 2017 cost $20 billion to treat. By 2045, according to the International Diabetes Federation, there will be 84 million sufferers costing $38 billion a year. According to the 2017 Global Burden of Disease study, health care costs will rise to more than $24 trillion by 2040 from $9.21 trillion in 2014. But, with fertility rates dropping everywhere, who will bankroll it?
Some countries are more vulnerable to the health care time bomb than others. Systems that have traditionally coddled their citizens in generous cradle-to-grave health care will be the first to come apart at the seams, as costs that were once manageable spiral out of control. In the UK, the National Health Service is crumbling under the weight of demand, with patients facing ever longer waiting times, even for emergency and cancer treatment.
Governments around the world are scrambling for short-term solutions. Many, including Denmark, Sweden and the UK, are increasing retirement ages, but some are fearful of taking such an unpopular step. Israel’s parliament approved raising the retirement age for women from 62 to 64 back in 2003, but nobody has since dared to actually implement the measure. Russia, China, India, Saudi Arabia and Turkey are among eight G-20 nations in which the retirement age for men is 60 years or younger.
The personal and wider economic tragedy is that poor health in our last years is entirely avoidable
Ultimately, no health system, however it is structured or funded, is immune to rising costs. Singapore operates a unique blend of public, personal and private provisions, in which individuals pay part of their salary into a personal health care fund, creating an investment that encourages them not only to take responsibility for their health but also to shop around for the best prices. But even Singapore’s standout model is showing signs of buckling under demographic pressures, with medical costs rising at 10 percent a year, outpacing global health care inflation of 8.4 percent.
Around the world, the Gulf included, governments are belatedly waking up to the need to educate populations about the perils of the good life. They are also considering other public health measures, from punitive taxes on sugary drinks to mandatory nutritional information on food. Better late than never, but all these initiatives have been tried elsewhere with little evidence so far that they have done any good.
The personal and wider economic tragedy is that poor health in our last years is entirely avoidable. Study after study has shown that the key factors driving up health care costs everywhere are medical conditions induced by our own poor personal lifestyle choices: Physical inactivity, obesity, high cholesterol and elevated blood pressure.
If there is any hope of defusing the health care time bomb, therefore, it surely lies in the phrase “personal responsibility.” Just as each of us must look to our personal impact on global warming, so we must consider the effect our lifestyles may have on our long-term health and on the economies of the societies in which we live. If we fail to do so, as with climate change, it will be our children who are left with the bill.
• Jonathan Gornall is a British journalist, formerly with The Times, who has lived and worked in the Middle East and is now based in the UK. Copyright: Syndication Bureau